{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMELA F HARTLESS","gend":1,"add":"4871 S RIVER RD","city":"VESUVIUS ","state":"VA","zip":"24483-9998","dob":"1999-03-15","age":"","mstatus":"","insh":11007128,"cliId":"2C68P31WJ32","pno":5403776423,"cno":5404601519,"email":"","ename":"","eno":"","pphy":"LENKER, LEON EDWARD  ","ppno":5408853525,"pcpadd":"40 LAMBERT STREET,SUITE 522","pcpcity":"STAUNTON ","pcpstate":"VA","pcpzip":244012446,"pcpcounty":"","pcpid":"P0124222","pcpname":"FAIRFIELD MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4871 S RIVER RD","madd2":"","madd3":"","mcity":"VESUVIUS ","mstate":"VA","mzip":"24483-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L40.0","L65.9","Z93.1","F84.0","G40.909","L22","R39.81","F72","N39.0","E44.1","R89.8","Z87.442","Z74.09","E83.59","R26.0","R63.1","N39.8","N29","R62.7","R62.50","R63.6","N20.9","F79","R21","G40.209","Q99.9","R62.52","M41.9","R26.89","L20.84","L85.3","R35.8","Q87.89","R29.818","G93.49","M81.0","Z13.820","Z23","N20.0","F41.9","N10","E87.0","M54.9","N23","N32.89","H57.89","Z43.1","Z15.09","N18.9","R32","R26.81","Z68.1","G40.219","K59.00","L01.00","F88","Z72.89"],"date":["2020-01-13","2020-01-29","2021-09-20","2021-10-06","2021-09-20","2021-10-31","2021-10-31","2021-10-31","2021-02-10","2020-03-03","2021-02-10","2021-03-25","2021-02-10","2021-03-25","2019-04-02","2019-04-02","2020-04-08","2021-03-25","2019-09-19","2019-09-19","2019-09-19","2019-09-19","2021-10-06","2019-07-22","2021-09-03","2019-09-24","2019-09-24","2021-02-19","2019-09-24","2019-06-25","2019-06-25","2019-07-22","2019-07-31","2021-02-19","2021-02-19","2019-12-26","2019-09-27","2021-11-11","2021-03-25","2021-10-06","2019-11-13","2019-11-13","2019-11-13","2019-11-13","2019-11-13","2019-11-20","2019-12-23","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2021-02-05","2021-02-10","2020-12-30","2021-10-06","2021-10-06"],"priorHcc":["","",null,"",null,null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","131541070","VIMPAT","SOL 10MG\/ML","","Select","Select",""],["","64980040906","SERTRALINE","CON 20MG\/ML","","Select","Select",""],["","78050883","TEGRETOL","SUS 100\/5ML","","Select","Select",""],["","378402101","DOXAZOSIN","TAB 1MG","","Select","Select",""],["","51991065116","LEVETIRACETA","SOL 100MG\/ML","","Select","Select",""],["","93417773","CEPHALEXIN","SUS 250\/5ML","","Select","Select",""],["","65862049647","SMZ-TMP","SUS 200-40\/5","","Select","Select",""],["","178050001","LITHOSTAT","TAB 250MG","","Select","Select",""],["","68180072210","CEFDINIR","SUS 125\/5ML","","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","","Select","Select",""],["","51672404806","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","93867574","AMOX\/K CLAV","SUS 600\/5ML","","Select","Select",""],["","59762502901","FLUCONAZOLE","SUS 10MG\/ML","","Select","Select",""],["","0","NYSTATIN","POW 100000","","Select","Select",""],["","168009960","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","713063437","MOMETASONE","CRE 0.001","","Select","Select",""],["","143988915","AMOXICILLIN","SUS 250\/5ML","","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","574012901","CLINDAMYCIN","SOL 75MG\/5ML","","Select","Select",""],["","65862049647","SMZ-TMP ","SUS 200-40\/5","100","Select","Select",""],["","51672128202","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","93417773","CEPHALEXIN ","SUS 250\/5ML","300","Select","Select",""],["","64980040906","SERTRALINE ","CON 20MG\/ML","180","Select","Select",""],["","378402101","DOXAZOSIN ","TAB 1MG","15","Select","Select",""],["","78050883","TEGRETOL ","SUS 100\/5ML","1,800.00","Select","Select",""],["","131541070","VIMPAT ","SOL 10MG\/ML","330","Select","Select",""],["","51991065116","LEVETIRACETA ","SOL 100MG\/ML","180","Select","Select",""],["","68180072210","CEFDINIR ","SUS 125\/5ML","100","Select","Select",""],["","178050001","LITHOSTAT ","TAB 250MG","15","Select","Select",""],["","59762502901","FLUCONAZOLE ","SUS 10MG\/ML","70","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","93867574","AMOX\/K ","SUS 600\/5ML","200","Select","Select",""],["","51672129803","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","713063437","MOMETASONE ","CRE 0.001","45","Select","Select",""],["","0","NYSTATIN ","POW 100000","100","Select","Select",""],["","143988915","AMOXICILLIN ","SUS 250\/5ML","150","Select","Select",""],["","574012901","CLINDAMYCIN ","SOL 75MG\/5ML","300","Select","Select",""],["","00093867574","AMOX\/K","600\/5ML","200","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}